Healthcare Provider Details

I. General information

NPI: 1073132494
Provider Name (Legal Business Name): BETHANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 W TOWN ST STE 102
COLUMBUS OH
43222-1694
US

IV. Provider business mailing address

867 W TOWN ST STE 102
COLUMBUS OH
43222-1694
US

V. Phone/Fax

Practice location:
  • Phone: 614-333-5335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: BRANDEN ELKINS
Title or Position: CONSULTANT
Credential:
Phone: 614-516-3155